Benefits Consultants II

CVS Health • Columbia, SC

3d • $17 - $31

About The Position

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary Aetna Better Health of Maryland is looking for a Medicaid Eligibility Retention Specialist to work with and assist current Aetna Better Health of Maryland (ABHMD) members to retain or renew their Medicaid eligibility and remain a member in the ABHMD Managed Care Organization (MCO) Plan, by preventing or rectifying the disenrollment of members due to loss of their Maryland Medicaid eligibility.

Requirements

• Associate's Degree or equivalent experience.
• Minimum Years’ Experience Required 3-5 years
• 2+ years’ experience specifically with Medicaid/Medicare program operations
• 1+ years’ experience with Medicaid policy, financing, program operations, business requirement development, or systems
• Experience working with Medicaid eligibility requirements, as well as enrollment, renewal and redetermination related regulations and process.
• Experience in customer service, specifically working with low-income and culturally diverse populations or, Medicaid enrolled or eligible individuals in person and on the phone.
• Experience working with healthcare systems/services and/or experience working with community organizations, social services and public resources.

Nice To Haves

• BA/BS Degree preferred.
• 3+ years of healthcare experience

Responsibilities

• Understand, and assure compliance to and adherence with, the Medicaid enrollment regulations, and related Maryland HealthChoice program policies and procedures related to Maryland HealthChoice member eligibility redetermination and renewals polices.
• Notify members, in accordance with ABHMD Policies & Procedures (which reflect Maryland Medicaid HealthChoice and Maryland COMAR regulations) of their loss of eligibility.
• Ensure copies of notices and documentation are filed in Members’ electronic records.
• Cultivate and maintain collaborative relationships - with primary care site partners, FQHC and community based outreach/enrollment organizations - to engage their assistance in working with members to maintain their Maryland Medicaid eligibility and correct information.
• Coordinate with Primary Care Sites when working with members on loss of Maryland Medicaid eligibility.
• Thoroughly log all member related interactions into Salesforce for the purpose of accurate tracking and analysis.
• Develop a process for effectively identifying members with issues and communicating resolution of the issue.
• Complete a Weekly Status Report for Supervisor and ABHMD Managers.
• Offer recommendations for improvements in ABHMD practices to enhance service delivery and member satisfaction.
• Participate in ABHMD sponsored meetings and events.
• Represent ABHMD in the community, when requested & provide other duties as assigned.

Benefits

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree